I recently wrote about the paradigm-shifting experience of exercise when I stumbled upon SoulCycle. I read about it when Chelsea Clinton held a Haiti fund-raising event there. I thought two things: wow, Chelsea has time to exercise? And cool, what is this exercise Chelsea does? I had to know and my discoveries are shared on HuffPost. If you haven't already, run, I tell you, run into your nearest SoulCycle and find out what its all about.
A novel and engaging form of spinning, SoulCycle engages body and brain in intense sessions which crest and soar on euphoria, guided imagery, candlelight and the unending surprise of discovering one's inner strength. Lately, all this cycling has started the cogwheels in my brain spinning. Quite literally, all this movement (internal and external) has got me thinking about motion.
Movement is medicine. And my spinning class certainly captures that, whether intentionally or not. A few days after my first class, I thought about the when I see my first patient one morning, an attractive 50-something year old who is planning gastric bypass surgery.
She has been referred to me to evaluate for the presence of obstructive sleep apnea syndrome that affects nine out of 10 people going for weight reduction surgery. Finding the obstructive sleep apnea syndrome, and treating it before, during and after surgery significantly improves cardiac and lung complications related to the surgery. It's important therefore to identify patients before surgery.
I enter the room and I am about to tell her all this and much more when I see fat, ripe tears filling her eyes. Before I can even greet my patient, she is crying. I give her time to weep. After a few moments, she begins to speak.
"My daughter is getting married in the summer. I have to look good for that. I can't look like this" and she sweeps her hand in contempt towards her body. She looked at me, and promptly started crying again.
"Oh, I used to look like you," she continued, "and wear exactly the same kind of outfits. I'll bring you a photo of how I used to look." She cried some more. I felt vaguely guilty. Something about my appearance that day had triggered a memory of her lost self, a memory she clearly grieved.
As we talked, I learned about her direct experience of 9-11 and how terrifying that had been for her. She then described the 'August Blackout" some years later, when she found herself stranded in Manhattan unable to get home because of train outages and massive, citywide power loss. She described how she spent the night curbside without shelter, in limbo, until power had been restored. Eventually, feeling chronically unsafe, insecure, and vulnerable, she abandoned a job she loved in the City which had been her longstanding passion and moved permanently to the suburbs. Clearly, this was a loss she was still dealing with. She went from a dynamic, brisk lifestyle in the pulsing city to feeling confined and paralyzed, not only literally in the realm of her new work away from New York, but also in the figurative sense. As a result of her fears, her life and world had become much smaller. Unsurprisingly, her fears, her worries had paralyzed her. There was no movement in her life. Food quickly became a self-medication -- fear a source of suffocation. The weight gain eventually devoured her old self.
Now she was pinning all her hopes on this surgery. Certainly, bariatric surgery, as we term it, can be highly effective for reducing weight and reducing it abruptly. Certified centers of excellence, like the one where I work (at Winthrop University Hospital) combine a high degree of surgical expertise with an extensive medical, psychological and behavioral approach, ensuring the impacts are lasting. Many patients are greatly helped by such programs.
We talked about what she had tried in terms of weight loss and the patient recounted many of the mainstream popular approaches of behavioral weight loss that we can all name without thinking.
I looked at my patient and wondered what she could accomplish if only she had access to the magic captured in the SoulCycle philosophy. If only her efforts could have been supported with the intangible benefits of visualization, guided imagery and plain old fashioned psychotherapy, perhaps she would have what she needed to move through this difficult part of her life: hope and encouragement, and above all, movement.
Movement is medicine. We have known that for a long time. So why then does American medicine espouse movement so poorly? We have created a surgical solution for disease which is fundamentally driven by the lack of movement in our lives, whether literal, or emotional, or oftentimes both. It really gave me pause. I have been treating patients for almost 20 years, talking to patients for 25, yet I know so little about the role of movement in health, and the way to help patients who are paralyzed by fear, difficulty, obstacles, or simply the grisly, arduous experience that is life.
I talk to her about strategies for exercise, ways to weave it into a busy, challenging life. The day of her consultation with me, the patient is convinced nothing can help her the way surgery can -- she has her heart set on a particular dress for the wedding and must 'reach goal' by then. Inside, I know she is correct. With the tools she has at her disposal, only 'banding' the stomach -- making it abnormally small -- will be the single most effective tool of managing her behavior and changing her eating in the short term. She has nothing else available to her. How sad. She had no confidence in other impacts on her behavior or her own ability to influence her own behavior. She had learned to believe she was not in control of her behavior. In her mind, only a surgeon could help.
I believe classes like SoulCycle can change that.
The words I heard in my first class, 'you are stronger than you think" keep revolving in my brain like the spokes on spinning wheels. These words which I first heard my instructor Christine D'Ercole say have generated a whirring, whooshing background against which I am building a new landscape. What if Christine was right? What if this was actually true? What if I am literally stronger than I imagine? What if my patient could feel the same?
When I think about this possibility, I discover my patient's doctor is not too different than the patient herself. Like my patient struggling to ready herself for her daughter's wedding, I also face challenges in the face of which I feel incapable -- attainments toward which I am mysteriously barred, beliefs that I have been simply not strong enough to change. What if I removed these self-imposed barriers, and opened the gate to the rolling vista of possibility which lies before all of us through the empowerment of movement?
This is one of the many reasons I have been wondering why can I not scribble exercise, including -- for those who are healthy enough to safely tolerate it -- spinning, on my prescription pad? Why is such exercise uncovered by most plans? It's not just the 550 - 650 calories an hour one burns in these workouts that brings health. It's impact is much more profound. Empowered movement, moving in a group, working out in a pack, can demolish the false ideas and confined measures of our own capabilities that we unhealthily hoard. Within the arrested time of a spinning class which successfully engages both mind and body we discover new inner realities. That's where its powerful medicine lies.
In sum, why is 'modern' medicine still so one-dimensional, so very not 21st Century? Why do insurance companies refuse coverage for what is fundamentally healing: medicine through movement and instead opt to cover what are largely intensely invasive, organ-specific interventional approaches? The answer is we as physicians haven't educated ourselves or third-party payors to the contrary. Instead, we remain married to archaic, traditional philosophies even if our medical technology has exceeded the age of Avatar. In our practice, we remain disease-centered at a time when we need to move to being truly patient-centered. Why have we placed no value on being patient-centered in our current system, instead, choosing to accept the inordinate costs of invasive, highly aggressive organ-specific approaches removed from the patient's actual life and function in society?
These questions will remain unanswered until we, as Americans, demand answers. We are living through the tumultuous birth of HealthCare reform and what a pained, bloody process this delivery is emerging to be. I guess it's a big baby and right now we are stuck in an intractable labor which threatens to turn into a 'failure to progress.' While we await the new arrival, here's a new thought: agreed, as a nation we most certainly need intelligent HealthCare and Health Insurance reform, but what we are in just as much need of is SelfCare Reform.
Americans have long abrogated their personal responsibility and, even more profoundly, their belief in being able to care for their own health and well-being . I am not referring to valuable and important screening for a malignancy, or careful measuring and monitoring of hemoglobin AIC, or a blood test for hepatitis or HIV. These are all important components to maintaining health and detecting disease. No. I am speaking to the belief that we have the ability to make ourselves, our families, and ultimately our entire lives healthier. Until we realize our abilities to engage in SelfCare, and call for SelfCare Reform, we will remain static, passive, disengaged, as patients and physicians.
When we do place a value on SelfCare ourselves, the market will too. Until then, I will not be able to write scripts for SoulCycle or indeed any other health-promoting self-driven patient behavior or intervention.
Instead of paying physicians for performance of our procedures, at the present time we can only dream of paying physicians for enhancing our patient's abilities to perform for themselves. What we need is not disease-centered health care, we need wellness-centered, patient-centered health care, namely SelfCare-centered healthcare. Wellness, nutrition and fitness is already a multi-billion-dollar industry. It's time we turned these elements into a movement for medicine, and make our nation, our world, our lives healthier, more confident and more within our own control.
Its time for SelfCare Reform, and my local SoulCycle on East 83rd may be just the first in many imaginative vehicles to carry us there, to carry us to a new kind of HealthCare - the SelfCare kind. How are you getting there?